Vaccine Pricing
Vaccine Pricing
- Seasonal Flu Vaccines
Part B payment allowance limits for seasonal influenza (flu) vaccines (that is, the vaccine product) are 95% of the Average Wholesale Price (AWP). In hospital outpatient departments, payment is based on reasonable cost.
Part B deductible and coinsurance amounts don’t apply for flu vaccine products or their administration. With respect to the vaccine product, all providers and suppliers must accept assignment on the claim.
The annual flu vaccine season is August 1–July 31 of the following year.
Get more information on frequency & coverage, billing, and coding.
Flu Season Payment Allowances & Effective Dates
Payment Allowances and Effective Dates for the 2023-2024 Flu Season:
Code Labeler Name Vaccine Name Payment Allowance Effective Dates 90662 Sanofi Pasteur Fluzone High-Dose Quadrivalent (2023/2024) $73.403
08/01/2023 – 07/31/2024 90672 MedImmune FluMist Quadrivalent (2023/2024) $27.788
08/01/2023 – 07/31/2024 90674 Seqirus Flucelvax Quadrivalent (2023/2024) (Preservative Free) $34.172
08/01/2023 – 07/31/2024 90682 Sanofi Pasteur Flublok Quadrivalent (2023/2024) (Preservative Free) $73.403
08/01/2023 – 07/31/2024 90686 GlaxoSmithKline Fluarix Quadrivalent (2023/2024) (Preservative free)
Flulaval Quadrivalent (2023/2024) (Preservative Free)
$22.350
08/01/2023 – 07/31/2024 Sanofi Pasteur Fluzone Quadrivalent (2023/2024) (Preservative Free) Seqirus Afluria Quadrivalent (2023/2024) (Preservative Free) 90687 Sanofi Pasteur Fluzone Quadrivalent 0.25ml (2023/2024) $10.439
08/01/2023 – 07/31/2024 Seqirus Afluria Quadrivalent 0.25ml (2023/2024) 90688 Sanofi Pasteur Fluzone Quadrivalent (2023/2024) $20.878
08/01/2023 – 07/31/2024 Seqirus Afluria Quadrivalent (2023/2024) 90694 Seqirus Fluad Quadrivalent (2023/2024) (Preservative Free) $77.359
08/01/2023 – 07/31/2024 90756 Seqirus Flucelvax Quadrivalent (2023/2024) $32.374
08/01/2023 – 07/31/2024 Payment limits and effective dates for newly approved and marketed influenza vaccines will be posted to this webpage.
Payment Allowances and Effective Dates for the 2022-2023 Flu Season:
Code Labeler Name Vaccine Name Payment Allowance Effective Dates 90662 Sanofi Pasteur Fluzone High-Dose Quadrivalent (2022/2023) $ 69.941 08/01/2022 – 07/31/2023 90672 MedImmune FluMist Quadrivalent (2022/2023) $ 26.876 08/01/2022 – 07/31/2023 90674 Seqirus Flucelvax Quadrivalent (2022/2023) (Preservative Free) $ 32.278 08/01/2022 – 07/31/2023 90682 Sanofi Pasteur Flublok Quadrivalent (2022/2023) (Preservative Free) $ 69.941 08/01/2022 – 07/31/2023 90686 GlaxoSmithKline
Sanofi Pasteur
Seqirus
Fluarix Quadrivalent (2022/2023) (Preservative Free)
Flulaval Quadrivalent (2022/2023) (Preservative Free)
Fluzone Quadrivalent (2022/2023) (Preservative Free)
Afluria Quadrivalent (2022/2023) (Preservative Free)$ 21.518 08/01/2022 – 07/31/2023 90687 Sanofi Pasteur
Seqirus
Fluzone Quadrivalent 0.25ml (2022/2023)
Afluria Quadrivalent 0.25ml (2022/2023)$ 10.241 08/01/2022 – 07/31/2023 90688 Sanofi Pasteur
Seqirus
Fluzone Quadrivalent (2022/2023)
Afluria Quadrivalent (2022/2023)$ 20.482 08/01/2022 – 07/31/2023 90694 Seqirus Fluad Quadrivalent (2022/2023) (Preservative Free) $ 71.682 08/01/2022 – 07/31/2023 90756 Seqirus Flucelvax Quadrivalent (2022/2023) $ 30.581 08/01/2022 – 07/31/2023 Payment limits and effective dates for newly approved and marketed influenza vaccines will be posted to this webpage.
Locality-Adjusted Payment Rates
- 2024 Locality-Adjusted Payment Rates for Influenza, Pneumococcal, Hepatitis B Vaccine Administration & In-Home Additional Payment (ZIP) [For claims with dates of service 1/1/2024-12/31/2024]
- 2023 Locality-Adjusted Payment Rates for Influenza, Pneumococcal and Hepatitis B Vaccine Administration - For claims with dates of service 1/1/2023–12/31/2023 (ZIP) * Updated 07/14/2023 to reflect locality revisions for Puerto Rico (PR) and the Virgin Islands (VI)
- 2022 Locality-Adjusted Payment Rates for Influenza, Pneumococcal and Hepatitis B Vaccine Administration (For Providers and Suppliers Paid MPFS-Adjusted Rates) – For claims with dates of service 1/1/2022–12/31/2022 (ZIP)
- 2021 Locality-Adjusted Payment Rates for Influenza, Pneumococcal and Hepatitis B Vaccine Administration (For Providers and Suppliers Paid MPFS-Adjusted Rates) – For claims with dates of service 1/1/2021–12/31/2021 (ZIP)
Archive Documents
- COVID-19 Vaccines & Monoclonal Antibodies
The COVID-19 public health emergency (PHE) ended at the end of the day on May 11, 2023. View Infectious diseases for a list of waivers and flexibilities that were in place during the PHE.
Review this page for information about Medicare payment for administering COVID-19 vaccines and monoclonal antibodies during and after the PHE.
Medicare Part B Payment for COVID-19 Vaccines & Certain Monoclonal Antibodies
This webpage provides the payment allowances and other related information for COVID-19 vaccines and certain monoclonal antibody products. Review the COVID-19 provider toolkit for more information about Medicare and COVID-19 during and after the PHE.
Payment Allowances & Effective Dates for COVID-19 Vaccines & Their Administration: (DOS = Date of Service, TBD = To Be Determined)
CPT Code or HCPCS Code CPT or HCPCS Short Descriptor Labeler Name Vaccine/Procedure Name National Payment Allowance Effective for Claims with DOS on or after 03/15/2021 National Payment Allowance Effective for Claims with DOS through 03/14/2021 Effective Dates for Medicare Payment 90480 ADMN SARSCOV2 VACC 1 DOSE N/A N/A $40.000[2] Code not active during this time 09/11/2023 - TBD M0201 Covid-19 vaccine home admin Home vaccine admin Covid-19 vaccine administration inside a patient's home; reported only once per individual home per date of service when only covid-19 vaccine administration is performed at the patient's home $35.50[2] Code not active during this time 06/08/2021 - TBD 91304 SARSCOV2 VAC 5MCG/0.5ML IM Novavax Novavax Covid-19 Vaccine, Adjuvanted (Aged 12 years and older) $148.200[7] Code not active during this time 07/13/2022 – TBD 91318 SARSCOV2 VAC 3MCG TRS-SUC Pfizer-BioNTech Pfizer-BioNTech COVID-19 Vaccine 2023-2024 Formula (Yellow Cap) $65.550 Code not active during this time 09/11/2023 - TBD
91319 SARSCV2 VAC 10MCG TRS-SUC IM Pfizer-BioNTech Pfizer-BioNTech COVID-19 Vaccine 2023-2024 Formula (Blue Cap) $87.780 Code not active during this time 09/11/2023 - TBD 91320 SARSCV2 VAC 30MCG TRS-SUC IM Pfizer-BioNTech COMIRNATY (COVID-19 Vaccine, mRNA) 2023-2024 Formula $131.100 Code not active during this time 09/11/2023 - TBD 91321 SARSCOV2 VAC 25 MCG/.25ML IM Moderna Moderna COVID-19 Vaccine 2023-2024 Formula $145.920 Code not active during this time 09/11/2023 - TBD 91322 SARSCOV2 VAC 50 MCG/0.5ML IM Moderna SPIKEVAX 2023-2024 Formula $145.920 Code not active during this time 09/11/2023 - TBD 91300 SARSCOV2 VAC 30MCG/0.3ML IM Pfizer Pfizer-BioNTech Covid-19 Vaccine (Aged 12 years and older) (Purple Cap) $0.010[1] $0.010[1] 12/11/2020 – 04/18/2023 0001A ADM SARSCOV2 30MCG/0.3ML 1ST Pfizer Pfizer-BioNTech Covid-19 Vaccine (Purple Cap) Administration – First Dose $40.000[2] $16.940[2] 12/11/2020 – 04/18/2023 0002A ADM SARSCOV2 30MCG/0.3ML 2ND Pfizer Pfizer-BioNTech Covid-19 Vaccine (Purple Cap) Administration – Second Dose $40.000[2] $28.390[2] 12/11/2020 – 04/18/2023 0003A ADM SARSCOV2 30MCG/0.3ML 3RD Pfizer Pfizer-BioNTech Covid-19 Vaccine (Purple Cap) Administration – Third Dose $40.000[2] Code not active during this time 08/12/2021 – 04/18/2023 0004A[4] ADM SARSCOV2 30MCG/0.3ML BST Pfizer Pfizer-BioNTech Covid-19 Vaccine (Purple Cap) Administration – Booster $40.000[2] Code not active during this time 09/22/2021 – 04/18/2023 91301 SARSCOV2 VAC 100MCG/0.5ML IM Moderna Moderna Covid-19 Vaccine (Aged 12 years and older) (Red Cap) $0.010[1] $0.010[1] 12/18/2020 – 04/18/2023 0011A ADM SARSCOV2 100MCG/0.5ML1ST Moderna Moderna Covid-19 Vaccine (Red Cap) Administration – First Dose $40.000[2] $16.940[2] 12/18/2020 – 04/18/2023 0012A ADM SARSCOV2 100MCG/0.5ML2ND Moderna Moderna Covid-19 Vaccine (Red Cap) Administration – Second Dose $40.000[2] $28.390[2] 12/18/2020 – 04/18/2023 0013A ADM SARSCOV2 100MCG/0.5ML3RD Moderna Moderna Covid-19 Vaccine (Red Cap) Administration – Third Dose $40.000[2] Code not active during this time 08/12/2021 – 04/18/2023 91303 SARSCOV2 VAC AD26 .5ML IM Janssen Janssen Covid-19 Vaccine (Aged 18 years and older)[3] $0.010[1] $0.010[1] 02/27/2021 – 06/01/2023 0031A ADM SARSCOV2 VAC AD26 .5ML Janssen Janssen Covid-19 Vaccine Administration - First Dose[3] $40.000[2] $28.390[2] 02/27/2021 – 06/01/2023 0034A ADM SARSCOV2 VAC AD26 .5ML B Janssen Janssen Covid-19 Vaccine Administration - Booster[3] $40.000[2] Code not active during this time 10/20/2021 – 06/01/2023 0041A ADM SARSCOV2 5MCG/0.5ML 1ST Novavax Novavax Covid-19 Vaccine, Adjuvanted Administration – First Dose $40.000[2] Code not active during this time 07/13/2022 – 10/03/2023 0042A ADM SARSCOV2 5MCG/0.5ML 2ND Novavax Novavax Covid-19 Vaccine, Adjuvanted Administration – Second Dose $40.000[2] Code not active during this time 07/13/2022 – 10/03/2023 0044A ADM SARSCOV2 5MCG/0.5ML BST Novavax Novavax Covid-19 Vaccine, Adjuvanted Administration - Booster $40.000[2] Code not active during this time 10/19/2022 – 10/03/2023 91305 SARSCOV2 VAC 30 MCG TRS-SUCR Pfizer Pfizer-BioNTech Covid-19 Vaccine Pre-Diluted (Aged 12 years and older) (Gray Cap) $0.010[1] Code not active during this time 01/03/2022 – 04/18/2023 0051A ADM SARSCV2 30MCG TRS-SUCR 1 Pfizer Pfizer-BioNTech Covid-19 Vaccine Pre-Diluted (Gray Cap) Administration - First dose $40.000[2] Code not active during this time 01/03/2022 – 04/18/2023 0052A ADM SARSCV2 30MCG TRS-SUCR 2 Pfizer Pfizer-BioNTech Covid-19 Vaccine Pre-Diluted (Gray Cap) Administration - Second dose $40.000[2] Code not active during this time 01/03/2022 – 04/18/2023 0053A ADM SARSCV2 30MCG TRS-SUCR 3 Pfizer Pfizer-BioNTech Covid-19 Vaccine Pre-Diluted (Gray Cap) Administration - Third dose $40.000[2] Code not active during this time 01/03/2022 – 04/18/2023 0054A[4] ADM SARSCV2 30MCG TRS-SUCR B Pfizer Pfizer-BioNTech Covid-19 Vaccine Pre-Diluted (Gray Cap) Administration - Booster $40.000[2] Code not active during this time 01/03/2022 – 04/18/2023 91306 SARSCOV2 VAC 50MCG/0.25ML IM Moderna Moderna Covid-19 Vaccine (Aged 18 years and older) (Red Cap) (Low Dose) $0.010[1] Code not active during this time 10/20/2021 – 04/18/2023 0064A[4] ADM SARSCOV2 50MCG/0.25MLBST Moderna Moderna Covid-19 Vaccine (Red Cap) (Low Dose) Administration - Booster $40.000[2] Code not active during this time 10/20/2021 – 04/18/2023 91307 SARSCOV2 VAC 10 MCG TRS-SUCR Pfizer Pfizer-BioNTech Covid-19 Pediatric Vaccine (Aged 5 years through 11 years) (Orange Cap) $0.010[1] Code not active during this time 10/29/2021 - 04/18/2023 0071A ADM SARSCV2 10MCG TRS-SUCR 1 Pfizer Pfizer-BioNTech Covid-19 Pediatric Vaccine (Orange Cap) Administration - First dose $40.000[2] Code not active during this time 10/29/2021 - 04/18/2023 0072A ADM SARSCV2 10MCG TRS-SUCR 2 Pfizer Pfizer-BioNTech Covid-19 Pediatric Vaccine (Orange Cap) Administration - Second dose $40.000[2] Code not active during this time 10/29/2021 - 04/18/2023 0073A ADM SARSCV2 10MCG TRS-SUCR 3 Pfizer Pfizer-BioNTech Covid-19 Pediatric Vaccine (Orange Cap) Administration - Third dose $40.000[2] Code not active during this time 01/03/2022 - 04/18/2023 0074A[4] ADM SARSCV2 10MCG TRS-SUCR B Pfizer Pfizer-BioNTech Covid-19 Pediatric Vaccine (Orange Cap) Administration - Booster $40.000[2] Code not active during this time 05/17/2022 - 04/18/2023 91308 SARSCOV2 VAC 3MCG TRS-SUCR Pfizer Pfizer-BioNTech Covid-19 Pediatric Vaccine (Aged 6 months through 4 years) (Maroon Cap) $0.010[1] Code not active during this time 06/17/2022 - 04/18/2023 0081A ADM SARSCOV2 3MCG TRS-SUCR 1 Pfizer Pfizer-BioNTech Covid-19 Pediatric Vaccine (Aged 6 months through 4 years) (Maroon Cap) Administration - First dose $40.000[2] Code not active during this time 06/17/2022 - 04/18/2023 0082A ADM SARSCOV2 3MCG TRS-SUCR 2 Pfizer Pfizer-BioNTech Covid-19 Pediatric Vaccine (Aged 6 months through 4 years) (Maroon Cap) Administration - Second dose $40.000[2] Code not active during this time 06/17/2022 - 04/18/2023 0083A ADM SARSCOV2 3MCG TRS-SUCR 3 Pfizer Pfizer-BioNTech Covid-19 Pediatric Vaccine (Aged 6 months through 4 years) (Maroon Cap) Administration - Third dose $40.000[2] Code not active during this time 06/17/2022 - 04/18/2023 91309 SARSCOV2 VAC 50MCG/0.5ML IM Moderna Moderna Covid-19 Vaccine (Aged 6 years through 11 years or aged 18 years and older) (Blue Cap with purple border) 50MCG/0.5ML[5] $0.010[1] Code not active during this time 03/29/2022 - 04/18/2023 0091A ADM SARSCOV2 50 MCG/.5 ML1ST Moderna Moderna Covid-19 Pediatric Vaccine (Aged 6 years through 11 years) (Blue Cap with purple border) Administration - First dose $40.000[2] Code not active during this time 06/17/2022 - 04/18/2023 0092A ADM SARSCOV2 50 MCG/.5 ML2ND Moderna Moderna Covid-19 Pediatric Vaccine (Aged 6 years through 11 years) (Blue Cap with purple border) Administration - Second dose $40.000[2] Code not active during this time 06/17/2022 - 04/18/2023 0093A ADM SARSCOV2 50 MCG/.5 ML3RD Moderna Moderna Covid-19 Pediatric Vaccine (Aged 6 years through 11 years) (Blue Cap with purple border) Administration - Third dose $40.000[2] Code not active during this time 06/17/2022 - 04/18/2023 0094A[4] ADM SARSCOV2 50MCG/0.5 MLBST Moderna Moderna Covid-19 Vaccine (Aged 18 years and older) (Blue Cap with purple border) 50MCG/0.5ML Administration - Booster $40.000[2] Code not active during this time 03/29/2022 - 04/18/2023 91311 SARSCOV2 VAC 25MCG/0.25ML IM Moderna Moderna Covid-19 Pediatric Vaccine (Aged 6 months through 5 years) (Blue Cap with magenta border) 250MCG/0.25ML $0.010[1] Code not active during this time 06/17/2022 - 04/18/2023 0111A ADM SARSCOV2 25MCG/0.25ML1ST Moderna Moderna Covid-19 Pediatric Vaccine (Aged 6 months through 5 years) (Blue Cap with magenta border) Administration - First dose $40.000[2] Code not active during this time 06/17/2022 - 04/18/2023 0112A ADM SARSCOV2 25MCG/0.25ML2ND Moderna Moderna Covid-19 Pediatric Vaccine (Aged 6 months through 5 years) (Blue Cap with magenta border) Administration - Second dose $40.000[2] Code not active during this time 06/17/2022 - 04/18/2023 0113A ADM SARSCOV2 25MCG/0.25ML3RD Moderna Moderna Covid-19 Pediatric Vaccine (Aged 6 months through 5 years) (Blue Cap with magenta border) Administration - Third dose $40.000[2] Code not active during this time 06/17/2022 - 04/18/2023 91312 SARSCOV2 VAC BVL 30MCG/0.3M Pfizer Pfizer-BioNTech COVID-19 Vaccine, Bivalent Product (Aged 12 years and older) (Gray Cap) $0.010[1] Code not active during this time 08/31/2022 – 09/12/2023 0124A ADM SARSCV2 BVL 30MCG/.3ML B Pfizer Pfizer-BioNTech COVID-19 Vaccine, Bivalent (Aged 12 years and older) (Gray Cap) Administration – Additional Dose $40.000[2] Code not active during this time 08/31/2022 – 09/12/2023 91313 SARSCOV2 VAC BVL 50MCG/0.5ML Moderna Moderna COVID-19 Vaccine, Bivalent Product (Aged 12 years and older) (Dark Blue Cap with gray border)[6] $0.010[1] Code not active during this time 08/31/2022 – 09/12/2023[6] 0134A ADM SARSCV2 BVL 50MCG/.5ML B Moderna Moderna COVID-19 Vaccine, Bivalent (Aged 12 years and older) (Dark Blue Cap with gray border) Administration – Additional Dose[6] $40.000[2] Code not active during this time 08/31/2022 – 09/12/2023[6] 91314 SARSCOV2 VAC BVL 25MCG/0.25ML Moderna Moderna COVID-19 Vaccine, Bivalent Product (Aged 6 months through 11 years) (Dark Blue Cap with gray border) $0.010[1] Code not active during this time 10/12/2022 – 09/12/2023 0144A ADM SARSCV2 BVL 25MCG/.25ML B Moderna Moderna COVID-19 Vaccine, Bivalent (Aged 6 years through 11 years) (Dark Blue Cap with gray border) Administration – Additional Dose $40.000[2] Code not active during this time 10/12/2022 – 09/12/2023 91315 SARSCOV2 VAC BVL 10MCG/0.2ML Pfizer Pfizer-BioNTech COVID-19 Vaccine, Bivalent Product (Aged 5 years through 11 years) (Orange Cap) $0.010[1] Code not active during this time 10/12/2022 – 09/12/2023 0154A ADM SARSCV2 BVL 10MCG/.2ML B Pfizer Pfizer-BioNTech COVID-19 Vaccine, Bivalent Product (Aged 5 years through 11 years) (Orange Cap) Administration – Additional Dose $40.000[2] Code not active during this time 10/12/2022 – 09/12/2023 91316 SARSCOV2 VAC BVL 10MCG/0.2ML Moderna Moderna COVID-19 Vaccine, Bivalent Product (Aged 6 months through 5 years) (Dark Pink Cap and a label with a yellow box) $0.010[1] Code not active during this time 12/08/2022 – 09/12/2023 0164A ADM SRSCV2 BVL 10MCG/0.2ML B Moderna Moderna COVID-19 Vaccine, Bivalent (Aged 6 months through 5 years) (Dark Pink Cap and label with a yellow box) Administration – Additional Dose $40.000[2] Code not active during this time 12/08/2022 – 09/12/2023 91317 SARSCOV2 VAC BVL 3MCG/0.2ML Pfizer Pfizer-BioNTech COVID-19 Vaccine, Bivalent Product (Aged 6 months through 4 years) (Maroon Cap) $0.010[1] Code not active during this time 12/08/2022 – 09/12/2023 0173A ADM SARSCV2 BVL 3MCG/0.2ML 3 Pfizer Pfizer-BioNTech Covid-19 Pediatric Vaccine (Aged 6 months through 4 years) (Maroon Cap) Administration - Additional Dose $40.000[2] Code not active during this time 12/08/2022 – 09/12/2023 0174A ADM SARSCV2 BVL 3MCG/0.2ML B Pfizer Pfizer-BioNTech Covid-19 Pediatric Vaccine (Aged 6 months through 4 years) (Maroon Cap) Administration – Additional Dose $40.000[2] Code not active during this time 03/14/2023 – 09/12/2023 0121A ADM SARSCV2 BVL 30MCG/.3ML 1 Pfizer Pfizer-BioNTech COVID-19 Bivalent (12 years and older) Administration – Single Dose $40.000[2] Code not active during this time 04/18/2023 - 09/12/2023 0151A ADM SARSCV2 BVL 10MCG/.2ML 1 Pfizer Pfizer-BioNTech COVID-19 Bivalent Pediatric Vaccine (5 years through 11 years) Administration – Single Dose $40.000[2] Code not active during this time 04/18/2023 - 09/12/2023 0171A ADM SARSCV2 BVL 3MCG/0.2ML 1 Pfizer Pfizer-BioNTech COVID-19 Bivalent Pediatric Vaccine (6 months through 4 years) Administration – First Dose $40.000[2] Code not active during this time 04/18/2023 - 09/12/2023 0172A ADM SARSCV2 BVL 3MCG/0.2ML 2 Pfizer Pfizer-BioNTech COVID-19 Bivalent Pediatric Vaccine (6 months through 4 years) Administration – Second Dose $40.000[2] Code not active during this time 04/18/2023 - 09/12/2023 0141A ADM SRSCV2 BVL 25MCG/.25ML 1 Moderna Moderna COVID-19 Vaccine, Bivalent Pediatric Vaccine (6 months through 11 years) Administration – First Dose $40.000[2] Code not active during this time 04/18/2023 - 09/12/2023 0142A ADM SRSCV2 BVL 25MCG/.25ML 2 Moderna Moderna COVID-19 Vaccine, Bivalent Pediatric Vaccine (6 months through 11 years) Administration – Second Dose $40.000[2] Code not active during this time 04/18/2023 - 09/12/2023 [1] Since we anticipate that providers, initially, won’t incur a cost for the product, CMS will update the payment allowance at a later date. Providers shouldn’t bill for the product if they got it for free.
[2] We’ll also geographically adjust these rates for many providers. We’ve included files with the geographically adjusted payment rates for COVID-19 vaccine administration in the “Additional Resources” section below. Certain settings use other payment methodologies, such as payment based on reasonable costs. Starting January 1, 2023, we’ll also annually update the COVID-19 vaccine payment rates to reflect changes in costs related to administering preventive vaccines.
[3] Johnson & Johnson COVID-19 vaccine. On May 5, 2022, the FDA limited the authorized use of the Janssen COVID-19 vaccine. On June 1, 2023, FDA revoked the EUA for this vaccine.
[4] Administration booster codes should be billed for all applicable booster doses as approved and/or authorized by the FDA.
[5] On June 17, 2022, FDA authorized the 50MCG/0.5ML presentation of the Moderna COVID-19 vaccine to provide primary series doses in individuals 6 - 11 years of age in addition to the March 29, 2022, FDA authorization to provide booster vaccination doses in individuals 18 years and older.
[6] On October 12, 2022, the FDA authorized the Moderna bivalent product (dark blue cap with gray border) and its administration for use as a single booster dose in individuals 12 - 17 years old in addition to the August 31, 2022, FDA authorization as a single booster dose in individuals 18 years and older.
[7] Effective October 3, 2023, CMS updated the payment allowance. Providers shouldn’t bill for the product if they got it for free.
Payment Allowances & Effective Dates for COVID-19 Monoclonal Antibodies & Their Administration:
HCPCS Code HCPCS Short Descriptor Labeler Name Vaccine/Procedure Name National Payment Allowance Effective for Claims with DOS on or after 05/6/2021 National Payment Allowance Effective for Claims with DOS through 05/5/2021 Effective Dates Q0220
Note: This product isn’t currently authorized[12]
Tixagev and cilgav, 300mg AstraZeneca Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), 300 mg $0.010[1] Code not active during this time period 12/08/2021 - TBD Q0221
Note: This product isn’t currently authorized[12]
Tixagev and cilgav, 600mg AstraZeneca Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), 600 mg $0.010[1] Code not active during this time period 02/24/2022 - TBD M0220
Note: This product isn’t currently authorized[12]
Tixagev and cilgav inj AstraZeneca Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), includes injection and post administration monitoring $150.50[3] Code not active during this time period 12/08/2021 - TBD M0221
Note: This product isn’t currently authorized[12]
Tixagev and cilgav inj hm AstraZeneca Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), includes injection and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergency
$250.50[3] Code not active during this time period 12/08/2021 - TBD Q0222
Note: This product isn’t currently authorized[11]
Bebtelovimab 175 mg Eli Lilly Injection, bebtelovimab, 175 mg $2394.00[1] [1a] Code not active during this time period 02/11/2022 - TBD M0222
Note: This product isn’t currently authorized[11]
Bebtelovimab injection Eli Lilly Intravenous injection, bebtelovimab, includes injection and post administration monitoring $350.50[3] Code not active during this time period 02/11/2022 - TBD M0223
Note: This product isn’t currently authorized[11]
Bebtelovimab injection home Eli Lilly Intravenous injection, bebtelovimab, includes injection and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergency $550.50[3] Code not active during this time period 02/11/2022 - TBD Q0239 Bamlanivimab-xxxx Eli Lilly Injection, bamlanivimab, 700 mg Code not active during this time period $0.010[1] 11/10/2020 – 04/16/2021[4] M0239 Bamlanivimab-xxxx infusion Eli Lilly Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring Code not active during this time period $309.600[3] 11/10/2020 – 04/16/2021[4] Q0240[6]
Note: This product isn’t currently authorized[9]Casirivi and imdevi 600mg Regeneron Injection, casirivimab and imdevimab, 600 mg $0.010[1] Code not active during this time period 07/30/2021 – TBD M0240[6]
Note: This product isn’t currently authorized[9]Casiri and imdev repeat Regeneron Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring, subsequent repeat doses $450.00[3] Code not active during this time period 07/30/2021 – TBD M0241[6]
Note: This product isn’t currently authorized[9]Casiri and imdev repeat hm Regeneron Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring in the home or residence, this includes a beneficiary's home that has been made provider-based to the hospital during the covid-19 public health emergency, subsequent repeat doses $750.00[3] Code not active during this time period 07/30/2021 – TBD Q0243
Note: This product isn’t currently authorized[9]Casirivimab and imdevimab Regeneron Injection, casirivimab and imdevimab, 2400 mg $0.010[1] $0.010[1] 11/21/2020 – TBD M0243
Note: This product isn’t currently authorized[9]Casirivi and imdevi inj Regeneron Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring $450.00[3] $309.600[3] 11/21/2020 – TBD Q0244[5]
Note: This product isn’t currently authorized[9]Casirivi and imdevi 1200 mg Regeneron Injection, casirivimab and imdevimab, 1200 mg $0.010[1] $0.010[1] 06/03/2021 – TBD M0244
Note: This product isn’t currently authorized[9]Casirivi and imdevi inj hm Regeneron Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergency $750.00[3] Code not active during this time period 05/06/2021 – TBD Q0245[8]
Note: This product isn’t currently authorized[9]Bamlanivimab and etesevima Eli Lilly Injection, bamlanivimab and etesevimab, 2100 mg $0.010[1] $0.010[1] 02/09/2021 – TBD M0245[8]
Note: This product isn’t currently authorized[9]Bamlan and etesev infusion Eli Lilly intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring $450.00[3] $309.600[3] 02/09/2021 – TBD M0246[8]
Note: This product isn’t currently authorized[9]Bamlan and etesev infus home Eli Lilly Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergency $750.00[3] Code not active during this time period 05/06/2021 – TBD Q0247[7]
Note: This product isn’t currently authorized[10]
Sotrovimab GSK Injection, sotrovimab, 500 mg $2394.00 Code not active during this time period 05/26/2021 – TBD M0247
Note: This product isn’t currently authorized[10]
Sotrovimab infusion GSK Intravenous infusion, sotrovimab, includes infusion and post administration monitoring $450.00[3] Code not active during this time period 05/26/2021 – TBD M0248
Note: This product isn’t currently authorized[10]
Sotrovimab inf, home admin GSK Intravenous infusion, sotrovimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergency $750.00[3] Code not active during this time period 05/26/2021 – TBD Q0249[2] Tocilizumab for COVID-19 Genentech Injection, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, 1 mg $6.572 Code not active during this time period 06/24/2021 - TBA M0249 Adm Tocilizu COVID-19 1st Genentech Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, includes infusion and post administration monitoring, first dose $450.00[3] Code not active during this time period 06/24/2021 - TBA M0250 Adm Tocilizu COVID-19 2nd Genentech Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, includes infusion and post administration monitoring, second dose $450.00[3] Code not active during this time period 06/24/2021 - TBA Q0224 Inj, pemivibart, 4500 mg Invivyd Injection, pemivibart, for the pre-exposure prophylaxis only, for certain adults and adolescents (12 years of age and older weighing at least 40 kg) with no known SARS-CoV-2 exposure, and who either have moderate-to-severe immune compromise due to a medical condition or receipt of immunosuppressive medications or treatments, and are unlikely to mount an adequate immune response to COVID-19 vaccination, 4500 mg $6,583.50 Code not active during this time period 03/22/2024 – TBD M0224 Pemivibart infusion Invivyd Intravenous infusion, pemivibart, for the pre-exposure prophylaxis only, for certain adults and adolescents (12 years of age and older weighing at least 40 kg) with no known SARS-CoV-2 exposure, who either have moderate-to-severe immune compromise due to a medical condition or receipt of immunosuppressive medications or treatments, includes infusion and post administration monitoring $450.00[3] Code not active during this time period 03/22/2024 – TBD [1] Providers shouldn't bill for the product if they got it for free through the USG-purchased inventory.
[1a] Payment rate effective for dates of service on or after August 15, 2022. Providers should only bill Medicare for commercially purchased products.
[2] Given the limited clinical situations allowed under the EUA, providers should only bill for tocilizumab on a 12x type of bill (TOB).
[3] We’ll geographically adjust these rates for many providers. We’ve included files with the geographically adjusted payment rates for monoclonal antibody administration in the “Additional Resources” section below. Certain settings use other payment methodologies, such as payment based on reasonable costs.
[4] On April 16, 2021, the FDA revoked the EUA that allowed for the investigational monoclonal antibody therapy bamlanivimab, when administered alone, to be used for the treatment of mild-to-moderate COVID-19 in adults and certain pediatric patients. As a result, Medicare won't pay for claims with HCPCS codes M0239 or Q0239 with dates of service after April 16, 2021.
[5] On June 3, 2021, the FDA revised the EUA for casirivimab and imdevimab to change the allowed dosing regimen from 2400 mg to 1200 mg and allow providers to administer the combination product by subcutaneous injection in limited circumstances. As a result, CMS issued a new product code for casirivimab and imdevimab (Q0244) and updated the descriptors for the existing administration codes (M0243/M0244).
[6] On July 30, 2021, the FDA revised the EUA for casirivimab and imdevimab to allow its use for post-exposure prophylaxis (PEP) in certain adult and pediatric patients. For patients who meet the criteria for repeat dosing, the authorized dosage is an initial dose of 1200 mg, followed by subsequent repeat dosing of 600 mg once every 4 weeks for the duration of ongoing exposure. As a result, CMS issued a new product code for casirivimab and imdevimab of 600 mg (Q0240) and 2 new codes for the administration of repeat doses of casirivimab and imdevimab (M0240/M0241). Providers who administer casirivimab and imdevimab for PEP should use M0243 or M0244 for administering the first dose and M0240 or M0241 for administering subsequent repeat doses.
[7] When the government provides monoclonal antibody products to treat COVID-19 for free, providers should only bill for the administration. Don’t include the monoclonal antibody product codes on these claims. If you got the product for free and your systems require a product code to bill for the administration, enter $0.01 for the billed amount.
[8] On September 16, 2021, the FDA revised the EUA for bamlanivimab and etesevimab, administered together, to allow its use for post-exposure prophylaxis (PEP) in certain adult and pediatric patients. Providers should use Q0245 and M0245 or M0246 to bill for administering bamlanivimab and etesevimab for PEP.
[9] On January 24, 2022, the FDA announced that, due to the high frequency of the Omicron variant, REGEN-COV (casirivimab and imdevimab, administered together) isn’t currently authorized in any U.S region. Therefore, you may not administer REGEN-COV for treatment or post-exposure prevention of COVID-19 under the EUA until further notice.
[10] On April 5, 2022, the FDA announced that, due to the high frequency of the Omicron BA.2 sub-variant, sotrovimab isn’t currently authorized in any U.S. region. Therefore, you may not administer sotrovimab to treat COVID-19 under the EUA until further notice.
[11] On November 30, 2022, the FDA announced that bebtelovimab isn’t currently authorized in any U.S. region because it isn’t expected to neutralize Omicron sub-variants BQ.1 and BQ.1.1. Therefore, you may not administer bebtelovimab to treat COVID-19 under the EUA until further notice.
[12] On January 26, 2023, the FDA announced that EVUSHELD isn’t currently authorized for emergency use in the U.S.
COVID-19 Vaccine Resources
- Get HCPCS codes for each product and its administration:
- COVID-19 CPT vaccine and immunization codes - AMA: View for long, medium, and short descriptions of COVID-19 CPT codes
- COVID-19 NDC-HCPCS crosswalk
- CDC COVID-19 Vaccination Resources
- COVID-19 Vaccination Training Programs and Reference Materials for Healthcare Professionals
- Information about Public Health Emergency
- COVID-19 Monoclonal Antibodies
- Quick reference guide to the coding structure for COVID-19 vaccine CPT reporting
- COVID-19 provider toolkit: Get more information about Medicare and COVID-19
- Vaccine Authorization Letters & Fact Sheets
- Monoclonal Antibody EUAs & Fact Sheets for Healthcare Providers
- ACTEMRA® (tocilizumab): EUA and EUA Fact Sheet
- Bamlanivimab: EUA and EUA Fact Sheet
- Bamlanivimab and etesevimab: EUA and EUA Fact Sheet
- Bebtelovimab: EUA and EUA Fact Sheet
- EvusheldTM (tixagevimab co-packaged with cilgavimab): EUA and EUA Fact Sheet
- PEMGARDA (pemivibart): EUA and EUA Fact Sheet
- REGEN-COV® (casirivimab and imdevimab): EUA and EUA Fact Sheet
- Sotrovimab: EUA and EUA Fact Sheet
Geographically-adjusted Payment Rates
2024
Jan 1 - Dec 2024 Geographically-adjusted Payment Rates for Monoclonal Antibody Administration (ZIP) [For claims with dates of service 1/1/2024-12/31/2024] * Updated 04/02/2024 to reflect the new codes for PEMGARDA [for claims with dates of service 03/22/2024-12/31/2024]
2023
Jan - Dec 2023 Geographically-adjusted Payment Rates for COVID-19 Vaccine Administration (ZIP) [For claims with dates of service 10/03/2023 through 12/31/2023] *Updated 10/05/2023 to remove codes describing the service to administer COVID-19 vaccines that are no longer authorized in the U.S. for the Novavax vaccine, Adjuvanted (effective 10/03/2023)
Jan - Dec 2023 Geographically-adjusted Payment Rates for Monoclonal Antibody Administration (ZIP) [For claims with dates of service 01/01/2023 through 12/31/2023] *Updated 07/14/2023 to reflect locality revisions for Puerto Rico (PR) and the Virgin Islands (VI)
2022
Jan - Dec 2022 Geographically-adjusted Payment Rates for COVID-19 Vaccine Administration (for Providers & Suppliers Paid MPFS-Adjusted Rates) (ZIP) *Updated 12/20/2022 to reflect the new codes for Moderna and Pfizer-BioNTech pediatric bivalent (updated COVID-19 vaccines) booster dose/
Jan - Dec 2022 Geographically-adjusted Payment Rates for Monoclonal Antibody Administration (for Providers & Suppliers Paid MPFS-Adjusted Rates) (ZIP) *Updated 02/17/2022 to reflect the new codes for bebtelovimab [For claims with dates of service 02/11/2022 through 12/31/2022]
2021
Jan - March 2021 Geographically-adjusted Payment Rates for COVID-19 Vaccine Administration (for Providers & Suppliers Paid MPFS-Adjusted Rates) (ZIP) *Updated February 16, 2021 for addition of the COVID-19 Janssen vaccine* [For claims with dates of service of 1/1/2021 through 3/14/2021]
March - Dec 2021 Geographically-adjusted Payment Rates for COVID-19 Vaccine Administration (for Providers & Suppliers Paid MPFS-Adjusted Rates) (ZIP) *Updated 11/02/2021 to account for effective dates for Pfizer-BioNTech COVID-19 Pediatric Vaccine [For claims with dates of service 3/15/2021 through 12/31/2021]
Jan-May 2021 Geographically-adjusted Payment Rates for Monoclonal Antibody Administration (for Providers & Suppliers Paid MPFS-Adjusted Rates) (ZIP) [For claims with dates of service of 1/1/2021 through 5/5/2021]
May-Dec 2021 Geographically-adjusted Payment Rates for Monoclonal Antibody Administration (for Providers & Suppliers Paid MPFS-Adjusted Rates) (ZIP) *Updated 12/23/2021 to account for new codes for tixagevimab co-packaged with cilgavimab* [For claims with dates of service 5/6/2021 through 12/31/2021]
- Get HCPCS codes for each product and its administration:
Page Last Modified:
04/09/2024 11:30 AM